Alastair Armstrong – Heart of steel

Twenty-two years after successful osteosarcoma treatment, Alastair Armstrong underwent an amputation due to ongoing infections caused by an internal prothesis. Despite this, he has won many SA titles competing as a paracyclist.

You can listen to this article below, or by using your favourite podcast player at pod.link/oncologybuddies

Alastair Armstrong (58) lives in Lanseria, Gauteng with his wife and three children. 

In 1994, at the age of 28, Alastair reached new heights as a professional cyclist and was signed with a major sponsor. Unfortunately, this occurred at the same time that he started feeling pain in his right knee. At first, he thought it was overuse but since the pain was getting worse and his leg couldn’t straighten, he sought help. He was referred to an orthopaedic surgeon. “For seven months, he tried to figure out what the issue was and sent me for so much physio, then he said I was generating the pain in my mind. By this time, I wasn’t riding anymore so went for a second opinion,” Alastair explains.

Within the first 10 minutes of the consultation, the new doctor had a suspicion that it was a tumour. Alastair went for an MRI and immediately the tumour was picked up behind the ligament on the side of the knee; a biopsy was the done. Alastair was diagnosed with osteosarcoma (cancer that starts in the bones). 

“I wasn’t happy that I had cancer, but I was happy that we finally knew what is was. All I wanted to know was when I would be able to cycle again,” Alastair says. 

Alastair believes this was his secret to success in his treatment process as his only focus was to cycle again. “I didn’t want to know anything about the cancer. My biggest focus was always looking to the future.”

Treatment

Alastair underwent chemotherapy for seven months. Next was surgery where the tumour was removed as well as half of his femur, knee joint, and forty percent of his muscle. A metal internal prothesis was specially made and inserted. 

“I think this is when I realised I would never cycle again professionally but I wasn’t down in the dumps, I was still focusing on tomorrow. My family support was massive, and you can’t underestimate family support. My mom lived with me during chemotherapy and the real blessing was that the cancer diagnosis made my sister and I closer,” Alastair says.

Triple breakage

After surgery, Alastair had limited movement but refused to be in a wheelchair and forced himself to walk. He underwent physiotherapy and recovered well. Though, he adds that his walk was different, and he felt hampered physically and lived with a lot of aches and pains. 

He married his wife (they connected during him undergoing chemotherapy) and he continued his go-getting Heart of Steel attitude which ultimately lead to him breaking his prothesis three times.  

The first time was five years into having it; even though Alastair was told he isn’t allowed to run or be as physically active as before, he didn’t listen and broke it while playing action cricket. The second time he was participating in The Dusi Canoe Marathon and the third time, he was practising Judo with his sons. “Exercise was my pain killer,” Alastair explains his reasoning.

Metallosis

After all three breakages, he underwent revision operations. However, it was in 2010 with the third operation that Alastair was diagnosed with metallosis (deposition and build-up of metal debris in the soft tissues of the body) caused by the metal prothesis. 

“I had little black bruises on my knee. I went to a dermatologist thinking it was a skin issue, but it was actually from having my prothesis in for too long. The lifespan of the prothesis was 12 years, I had this one in for 16 years,” he says.

The prothesis was removed completely with a splint in its place and antibiotics were administered. The doctor gave strict instruction to stay in bed for a month and a half, which Alastair begrudgingly complied with. A new titanium prothesis was inserted and physiotherapy took place. 

However, during a session, the wound opened which indicated another infection. Alastair was in hospital for four months with septicaemia (a life-threatening condition when the body has a severe response to an infection) as well as the superbug, Coxiella burnetii. He underwent numerous plastic surgeries to try and close the wound as well as hyperbaric therapy, but nothing was working. The last resort was when Alastair’s calf muscle was used to close the wound, there was progress, but mobility was problematic. Alastair was told by his doctor to please consider amputation. Alastair admits that by this time, he was starting to break mentally, and he was referred to a psychologist. 

“I just wanted to go home after so much time in hospital,” Alastair says. After an intense discussion and his wife getting training to care for him, Alastair was able to go home during December and get stronger.

Amputation  

For a long while Alastair refused an amputation. But after bumping his leg, the infection came back, and it was a continuous battle of clearing the infection and it reoccurring. He eventually agreed to an amputation, in 2016, but on two occasions he refused to go to the hospital for the planned surgery. It was a third time that he went ahead, with all the surgery staff clapping when he was wheeled into theatre. His lower leg was amputated above the knee but the femur leg extension prothesis was left in for better mobility.

“Immediately I felt stronger with the majority of the prothesis out. I didn’t have a leg, but I could feel something was different, it was like that slow puncture was gone,” 

Alastair explains. “Three months later, I got a prosthetic leg and life was great. Until a year and a bit later, I got a blister on my stump from the prosthetic leg; the infection was back.”

Alastair confesses that he was fearful of another operation since he was the breadwinner and at that time his children’s education was a priority, so he lived with the low-grade infection for six years. 

He finally had the upper extension of the prothesis removed last year October due to him not being able to function as the infection was causing havoc. 

“After the last operation, I was happy to be alive. My stump is shorter now, but recovery went well and once again I just wanted to get back to cycling,” Alastair says. 

Competing as a paracyclist

Even though Alastair was always physically active despite his doctor’s orders, it was due to his daughter taking an interest in cycling that got him back into it. “We witnessed another paraathlete competing without a leg and my daughter looked at me and said, ‘What’s your excuse?’ So, I got back onto a bike and it was so hard for the first seven months. Then, it was like a light bolt went off, it’s like the body just remembered.” 

Once Alastair got stronger and trained more, Alastair classified himself as a paracyclist in 2019 and started competing, winning many SA titles even with the low-grade infection. “This allowed me to have so many beautiful experiences with my daughter.”

Since having the last operation, Alastair decided to buy a new bicycle rather than a prosthetic leg. “My daughter was the only one who supported my decision,” he says laughing.

Alastair only has one regret and that is that he never classified himself as a paracyclist in his thirties.